Adult urologyUrinary tract erosions after synthetic pubovaginal slings: diagnosis and management strategy
Section snippets
Material and methods
A retrospective review of the operating room and outpatient records from the urology and gynecology services at two university hospitals (University of Michigan and University of Texas, Houston) was carried out. All patients who were diagnosed with a urogenital tract erosion after a pubovaginal sling procedure were identified. Erosion was defined as the presence of foreign material (sutures, sling material, bone anchors) within the urogenital tract. The interval from sling placement to
Results
Between December 1997 and March 2000, 14 patients were diagnosed with a urogenital tract erosion after placement of a pubovaginal sling. All sling procedures but one were performed elsewhere and then referred for further management. Pertinent patient characteristics are given in Table I. Six patients had an isolated vaginal erosion, six had both vaginal and urethral erosions, and two had erosions into the bladder. The mean time from sling placement to treatment of the erosions was 11.2 months
Comment
Because of its durability, the autologous fascia pubovaginal sling has emerged as the reference standard treatment for female stress urinary incontinence. The perceived disadvantages of the procedure include its technical difficulty, problems with postoperative urinary retention, incisional pain from the fascial harvest site, and the requirement for postoperative hospitalization. As a result, new techniques have been developed that use sling technology while minimizing these disadvantages. To
Conclusions
Urogenital tract erosions after pubovaginal slings are significant complications that typically result in many months of patient pain and distress before the problem is diagnosed. Patients with unexplained pain, vaginal discharge, irritative voiding symptoms, or recurrent urinary tract infections should be thoroughly evaluated with a pelvic examination and cystoscopy. Once diagnosed, immediate and dramatic symptomatic relief should be expected after removal of the eroded sling components. For
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